ADVANCE DIRECTIVES
Mini Hanspal RN, BSN, CMSRN
WHAT IS ADVANCE CARE PLANNING
It is a regulatory requirement that we inquire about the presence
of an Advance Directive and offer assistance in completing one for
each inpatient admission.
At CMC, we are dedicated to providing assistance with the
documentation, storage, retrieval, and honoring of patients’ advance
care planning as it is essential for providing quality that reflects the
goals and values of our patients.
TERMINOLOGY
The most common document that can result from advance care
planning is the Advance Directive. Every adult should have an
advance directive, no matter if they are healthy or ill.
A patient with an advance directive has designated a person to be
their health care agent.
The purpose of an agent is to speak in the place of the patient
when the patient cannot speak them for themselves.
TERMINOLOGY
If there is no advance directive naming a healthcare agent, we use
California Consent law guidelines to determine the appropriate
surrogate decision maker.
It is best to allow a patient to name their surrogate decision maker.
If we don’t have one on record for an admission, one will be chosen
for the patient, if they lose the ability to make their own decision.
ASSESSING FOR ADVANCE DIRECTIVE
Nursing does not inquire about patient preference for code status.
This discussion is outside nursing scope of practice.
The provider is responsible to address code status with the patient
or their agent.
If a patient requests a code status other than “full code”, notify
the provider of their request and document the discussion.
ADVANCE CARE PLANNING DOCUMENTS
ACP wishes can be documented in different ways:
• Advance Directive -
• POLST
• Oral Directive
ORAL DIRECTIVE
A patient who has decision making capacity has the right to give
verbal statement about their medical care
If a patient expresses the desire to dictate an oral directive, the RN
must document the request in the patient’s chart and notify the
provider.
ORAL DIRECTIVE
If a patient wishes to give an oral directive on this admission,
select this and the provider will be alerted with a banner. In some
cases a call to the provider is appropriate.
Remember, the oral directive and code status discussion is the
responsibility of the provider.
ADVANCE CARE DOCUMENTS
Do not chart a document that you do not see.
If family agrees to bring a document, chart when you receive the
document.
ACP NAVIGATOR
RN ROLE:
Assess for existing documents on admission
Confirm available documents
Enter the appropriate document information
Do not chart a document unless you see it.
Document agent or surrogate information.
Update ACP navigator as new information is obtained.
QUESTIONS?
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